Background: Bipolar disorder (BD) is a significant cause of perinatal morbidity and mortality. Because BD is hard to detect and treat, these individuals often go without care. This dissertation was designed to: (1) identify the prevalence rates of BD and bipolar-spectrum mood episodes in perinatal individuals, (2) understand pertinent barriers to mental healthcare, and (3) elucidate how to bridge healthcare gaps. Methods: Data sources included: primary qualitative and quantitative data from obstetric clinicians, encounter data from Massachusetts Child Psychiatry Access Program (MCPAP) for Moms, a program aimed at helping clinicians to provide mental healthcare to perinatal patients. Analyses included: descriptive statistics, systematic review and meta-analysis, qualitative data analyses, longitudinal regression analyses, and group-based trajectory modeling. Results: The prevalence of BD in perinatal individuals was 2.6% (95% CI: 1.2 to 4.5%). Twenty to 54.9% were found to have a bipolar-spectrum mood episode. Barriers to mental healthcare for perinatal patients with BD included the paucity of psychiatric resources, difficulties in assessing BD, and stigma towards pharmacotherapy. Obstetric clinicians reported that MCPAP for Moms has helped them feel more comfortable in treating patients with BD. Longitudinal analyses of encounter data corroborated these findings - utilization of the program predicted increased clinician capacity to treat BD. Conclusion: Clinicians for perinatal individuals are being called upon and stepping up to care for complex illnesses like BD. Programs like MCPAP for Moms can help them feel more confident in this role, helping to bridge gaps in perinatal mental healthcare and ensuring that individuals with BD are able to receive appropriate care.

The purpose of this study was to identify risk factors associated with homelessness, assess the relationship between housing status and consumption of costly publicly funded resources, to identify characteristics associated with service retention, and to evaluate whether length of treatment is associated with better outcomes. The target population was homeless and formerly homeless adults with SMI enrolled in community mental health services at the Downtown Emergency Service Center SAGE mental health program located in Seattle. The sample consisted of 380 SAGE patients who had continuous enrollment in 2005. These patients formed the cohort for the study. Agency records for these patients were reviewed for a 3-year period (2005-2007). The study utilized a non-experimental retrospective cohort study design. Multiple logistic regression, hierarchical multiple regression, two-way repeated measures ANOVA, and Cochran's Q test were used to analyze the data. Homelessness was associated with African American race, substance use, lower income, and younger age. Patients who were homeless spent more time in jail and required more mental health staff time compared with patients with stable housing. Patients with schizophrenia were more likely to retain services and African American patients were less likely to retain services. Overall, patients who remained enrolled in services from Year 1 to Year 3 had improved housing stability, fewer days of incarceration, and required less staff support. The overrepresentation of African Americans among patients who experienced homelessness suggests that racism could be a factor contributing to homelessness for this racial group. Further research is needed to assess the relationship between race and homelessness.

Purpose: The purpose of this integrative literature review is to explore the effectiveness of different training modalities on the acquisition and retention of CPR knowledge and psychomotor skill among undergraduate nursing students. Background: It is well known that standard CPR-training is ineffective at preparing nurses for the rigors of a cardiac arrest event. Survival rates for in-hospital cardiac arrests remain low and the proportion of neurobehavioral sequelae among survivors is very high. Methods: A review of relevant literature published between 2006 and 2016 was conducted using the CINAHL and MEDLINE databases. The following key terms were used in the search: ‘student*’, ‘nurs* student*’, ‘cardiopulmonary resuscitation (CPR)’, ‘Basic Life Support (BLS)’, ‘Advanced Life Support (ALS)’, ‘Advanced Cardiac Life Support (ACLS)’, and ‘Retention’. Results: The initial database search yielded a total of sixty-seven articles; of which, nine articles met the inclusion criteria and were utilized in the final analysis. The articles analyzed explored the effectiveness of different training modalities including: self-directed, CD-based, low-fidelity simulation, high-fidelity simulation, collaborative high-fidelity simulation, and deliberate practice. Conclusion: Current training is ineffective both in promoting long-term retention and in delaying the decay of previously learned information. The most effective training modality identified was high-fidelity simulation in conjunction with deliberate practice. The use of collaborative simulation through ‘mock codes’ maximizes the acquisition and retention of CPR knowledge and skill by providing the highest degree of fidelity. Deliberate practice was the only modality, which resulted in improvement of knowledge and skill over time. The absence of individualized feedback diminishes the effects of repeated practice. Practical experience is also susceptible to the detrimental effects exerted by the lack of feedback.

<p>Alzheimer’s disease (AD) is a degenerative disease with progressive deterioration of neural networks in the brain. Fractal dimension analysis (FD) of resting state blood oxygen level dependent (BOLD) signals acquired using functional magnetic resonance imaging (fMRI) allows us to quantify complex signalling in the brain and may offer a window into the network erosion. This novel approach can provide a sensitive tool to examine early stages of AD. As AD progresses, we expect to see a reduction in brain connectivity and signal complexity concurrent with biochemical changes (e.g. altered levels of N-acetyl aspartate (NAA), myoinositol (mI) and glutamate as measured using magnetic resonance spectroscopy, MRS), volumetric changes and abnormally high levels of brain iron.</p> <p>Over a series of 4 studies we examined the relationship of BOLD signal complexity and functional connectivity with documented MRI markers of pathology in AD (n=38) as compared to normal controls (NC) (n=16). AD subjects were in early stage of illness (mild to moderate impairment on the mini mental state exam, MMSE). We validated the temporal (short term (within minutes) and longer term (over a number of months)) consistency of FD measurement and choice of BOLD acquisition method (spiral vs. EPI), provided MRI sequence repeat time (TR) was kept constant. FD reduction (decrease in signal complexity) correlated with worsening pathological values on MRS (­NAA decrease and mI increase) and with a decrease in functional connectivity. This demonstrates that FD (signal complexity) reduces in proportion to AD severity. FD reduction is connected to functional connectivity measured through resting state network (RSN) analysis suggesting the reduction in FD relates to neuronal loss rather than altered vascularity. The narrow range of cognitive impairment (such as scores on the MMSE or the clinical dementia rating scale, CDR) likely precluded correlation between these measures and FD or RSN. Functional connectivity (RSN) was also reduced when brain iron levels were increased within certain network nodes (posterior cingulate cortex and lateral parietal cortex). Therefore iron deposition may play a role in network disruption of AD brains.</p> <p>The overall conclusion of this thesis is that signal complexity of BOLD fMRI signals, as measured with FD, may detect early pathology in the progression of AD. FD can detect neuronal changes in deep brain structures before volume loss in these structures and before significant changes in MRS markers were detectable between the AD and NC groups. An FD change mirrors disruptions in functional connectivity but detection is not limited to RSN nodes in the brain. This novel approach could further our understanding of AD and may be applied to other pathologies of the brain.</p> / Doctor of Philosophy (PhD)

<p>Anti-psychotic drug (APD) administration can induce movement disorders including tardive dyskinesia (TD), characterized by abnormal movements of the oro-facial region and occasionally the trunk and limbs. The most widely accepted model of TD is the APD-induced vacuous chewing movement (VCM). While the mechanism of induction of TD remains unclear, there are two prevailing hypothesis: oxidative stress and dopamine supersensitivity. Currently available APDs antagonize dopamine D2 receptors (D2R) which can result in excessive dopamine accumulation and oxidation which was demonstrated to induce striatal neurodegeneration and increased oxidative stress. The dopamine supersensitivity hypothesis proposes that APD treatment causes an up-regulation of high affinity D2Rs to compensate for D2R antagonism. Curcumin, a derivative of turmeric, has been demonstrated to affect dopamine levels and hold significant anti-apoptotic potential. Thus, the goal of this study was to investigate curcumin’s potential to prevent haloperidol-induced behavioural and biochemical abnormalities. Four groups of rats were treated daily: control; haloperidol (at 2mg/kg intra-peritoneally); curcumin (at 200mg/kg orally in jello) and curcumin plus haloperidol. VCMs, catalepsy and locomotor activity were assessed. Animals were sacrificed and tissues removed for qPCR, immunoblot, receptor binding, and UPLC assessments. At day14 there was a significant increase in VCMs and catalepsy following haloperidol treatment, which was prevented by curcumin treatment. However, curcumin did not alter locomotor activity. Curcumin was demonstrated to increase the expression of the anti-apoptotic molecule BclXL and to increase striatal D2Rs. These investigations support the potential of curcumin in the prevention of TD and provide insight into the complex pathophysiology of this disorder.</p> / Doctor of Philosophy (Medical Science)

More than 2.6 million troops have deployed in support of the wars in Iraq and Afghanistan. Still, surveys reveal that more than half feel “disconnected” from their civilian counterparts, and this feeling persists despite ongoing efforts, in the academy and elsewhere, to help returning veterans overcome physical and mental wounds, seek an education, and find meaningful ways to contribute to society after taking off the uniform. This dissertation argues that Iraq and Afghanistan War veterans struggle with reassimilation because they lack healthy, complete models of veteran identity to draw upon in their postwar lives, a problem they’re working through collectively in literature and artwork. The war veteran—returning home transformed by the harsh realities of military training and service, having seen humanity at its extremes, and interacting with a society apathetic toward his or her experiences—should engage in the act of storytelling. This act of sharing experiences and crafting-self subverts stereotypes. Storytelling, whether in a book read by millions, or in a single conversation with a close family member, should instruct civilians on the topic of human resiliency; it should instruct veterans on the topic of homecoming. But typically, veterans do not tell stories. Civilians create barriers to storytelling in the form of hollow platitudes—“thank you for your service” or “I can never understand what you’ve been through”—disconnected from the meaning of wartime service itself. The dissonance between veteran and civilian only becomes more complicated when one considers the implicit demands and expectations attached to patriotism. These often well-intentioned gestures and government programs fail to convey a message of appreciation because they refuse to convey a message of acceptance; the exceptional treatment of veterans by larger society implies also that they are insufficient, broken, or incomplete. So, many veterans chose conformity and silence, adopting one of two identities available to them: the forever pitied “Wounded Warrior” or the superficially praised “Hero.” These identities are not complete. They’re not even identities as much as they are collections of rumors, misrepresentations, and expectations of conformity. Once an individual veteran begins unconsciously performing the “Wounded Warrior” or “Hero” character, the number of potential outcomes available in that individual’s life is severely diminished. Society reinforces a feeling among veterans that they are “different.” This shared experience has resulted in commiseration, camaraderie, and also the proliferation of veterans’ creative communities. As storytellers, the members of these communities are restoring meaning to veteran-civilian discourse by privileging the nuanced experiences of the individual over stereotypes and emotionless rhetoric. They are instructing on the topics of war and homecoming, producing fictional and nonfictional representations of the veteran capable of competing with stereotypes, capable of reassimilation. The Introduction establishes the existence of veteran culture, deconstructs notions of there being a single or binary set of veteran identities, and critiques the social and cultural rhetoric used to maintain symbolic boundaries between veterans and civilians. It begins by establishing an approach rooted in interdisciplinary literary theory, taking veteran identity as its topic of consideration and the American unconscious as the text it seeks to examine, asking readers to suspend belief in patriotic rhetoric long enough to critically examine veteran identity as an apparatus used to sell war to each generation of new recruits. Patriotism, beyond the well-meaning gestures and entitlements afforded to veterans, also results in feelings of “difference,” in the veteran feeling apart from larger society. The inescapability of veteran “difference” is a trait which sets it apart from other cultures, and it is one bolstered by inaccurate and, at times, offensive portrayals of veterans in mass media and Hollywood films such as The Manchurian Candidate (1962), First Blood (1982), or Taxi Driver (1976). To understand this inescapability the chapter engages with theories of race, discussing the Korean War veteran in Home (2012) and other works by Toni Morrison to directly and indirectly explore descriptions of “difference” by African Americans and “others” not in positions of power. From there, the chapter traces veteran identity back to the Italian renaissance, arguing that modern notions of veteran identity are founded upon fears of returning veterans causing chaos and disorder. At the same time, writers such as Sebastian Junger, who are intimately familiar with veteran culture, repeatedly emphasize the camaraderie and “tribal” bonds found among members of the military, and instead of creating symbolic categories in which veterans might exist exceptionally as “Heroes,” or pitied as “Wounded Warriors,” the chapter argues that the altruistic nature which leads recruits to war, their capabilities as leaders and educators, and the need of larger society for examples of human resiliency are more appropriate starting points for establishing veteran identity. The Introduction is followed by an independent “Example” section, a brief examination of a student veteran named “Bingo,” one who demonstrates an ability to challenge, even employ veteran stereotypes to maintain his right to self-definition. Bingo’s story, as told in a “spotlight” article meant to attract student veterans to a college campus, portrays the veteran as a “Wounded Warrior” who overcomes mental illness and the scars of war through education, emerging as an exceptional example—a “Hero”—that other student veterans can model by enrolling at the school. Bingo’s story sets the stage for close examinations of the “Hero” and the “Wounded Warrior” in the first and second chapters. Chapter One deconstructs notions of heroism, primarily the belief that all veterans are “Heroes.” The chapter examines military training and indoctrination, Medal of Honor award citations, and film examples such as All Quiet on the Western Front (1930), Heroes for Sale (1933), Sergeant York (1941), and Top Gun (1986) to distinguish between actual feats of heroism and “Heroes” as they are presented in patriotic rhetoric. The chapter provides the Medal of Honor citations attached to awards presented to Donald Cook, Dakota Meyer, and Kyle Carpenter, examining the postwar lives of Meyer and Carpenter, identifying attempts by media and government officials to appropriate heroism—to steal the right to self-definition possessed by these men. Among these Medal of Honor recipients one finds two types of heroism: Sacrificing Heroes give something of themselves to protect others; Attacking Heroes make a difference during battle offensively. Enduring Heroes, the third type of heroism discussed in the chapter, are a new construct. Colloquially, and for all intents and purposes, an Enduring Hero is simply a veteran who enjoys praise and few questions. Importantly, veterans enjoy the “Hero Treatment” in exchange for silence and conforming to larger narratives which obfuscate past wars and pave the way for new ones. This chapter engages with theorists of gender—such as Jack Judith Halberstam, whose Female Masculinities (1998) anticipates the agency increasingly available to women through military service; like Leo Braudy, whose From Chivalry to Terrorism (2003) traces the historical relationship between war and gender before commenting on the evolution of military masculinity—to discuss the relationship between heroism and agency, begging a question: What do veterans have to lose from the perpetuation of stereotypes? This question frames a detailed examination of William A. Wellman’s film, Heroes for Sale (1933), in the chapter’s final section. This story of stolen valor and the Great Depression depicts the homecoming of a WWI veteran separated from his heroism. The example, when combined with a deeper understanding of the intersection between veteran identity and gender, illustrates not only the impact of stolen valor in the life of a legitimate hero, but it also comments on the destructive nature of appropriation, revealing the ways in which a veteran stereotypes rob service men and women of the right to draw upon memories of military service which complete with those stereotypes. The military “Hero” occupies a moral high ground, but most conceptions of military “Heroes” are socially constructed advertisements for war. Real heroes are much rarer. And, as the Medal of Honor recipients discussed in the chapter reveal, they, too, struggle with lifelong disabilities as well as constant attempts by society to appropriate their narratives. Chapter Two traces the evolution of the modern “Wounded Warrior” from depictions of cowardice in Stephen Crane’s The Red Badge of Courage (1895), to the denigration of World War I veterans afflicted with Shell Shock, to Kevin Powers’s Iraq War novel, The Yellow Birds (2012). As with “Heroes,” “Wounded Warriors” perform a stereotype in place of an authentic, individualized identity, and the chapter uses Walt Kowalski, the protagonist of Clint Eastwood’s film, Gran Torino (2008), as its major example. The chapter discusses “therapeutic culture,” Judith Butler’s work on identity-formation, and Eva Illouz’s examination of a culture obsessed with trauma to comment on veteran performances of victimhood. Butler’s attempts to conceive of new identities absent the influence of systems of definition rooted in the state, in particular, reveal power in the opposite of silence, begging another question: What do civilians have to gain from the perpetuation of veteran stereotypes? Largely, the chapter finds, the “Wounded Warrior” persists in the minds of civilians who fear the veteran’s capacity for violence. A broken, damaged veteran is less of a threat. The story of the “Wounded Warrior” is not one of sacrifice. The “Wounded Warrior” exists after sacrifice, beyond any measure of “honor” achieved in uniform. “Wounded Warriors” are not expected to find a cure because the wound itself is an apparatus of the state that is commodified and injected into the currency of emotional capitalism. This chapter argues that military service and a damaged psyche need not always occur together. Following the second chapter, a close examination of “The Bear That Stands,” a short story by Suzanne S. Rancourt which confronts the author’s sexual assault while serving in the Marines, offers an alternative to both the “Hero” and the “Wounded Warrior” stereotypes. Rancourt, a veteran “Storyteller,” gives testimony of that crime, intervening in social conceptions of veteran identity to include a female perspective. As with the example of Bingo, the author demonstrates an innate ability to recognize and challenge the stereotypes discussed in the first and second chapters. This “Example” sets the stage for a more detailed examination of “Veteran Storytellers” and their communities in the final chapter. Chapter Three looks for examples of veteran “difference,” patriotism, the “Wounded Warrior,” and the “Hero” in nonfiction, fiction, and artwork emerging from the creative arts community, Military Experience and the Arts, an organization which provides workshops, writing consultation, and publishing venues to veterans and their families. The chapter examines veteran “difference” in a short story by Bradley Johnson, “My Life as a Soldier in the ‘War on Terror.’” In “Cold Day in Bridgewater,” a work of short fiction by Jerad W. Alexander, a veteran must confront the inescapability of that difference as well as expectations of conformity from his bigoted, civilian bartender. The final section analyzes artwork by Tif Holmes and Giuseppe Pellicano, which deal with the problems of military sexual assault and the effects of war on the family, respectively. Together, Johnson, Alexander, Holmes, and Pellicano demonstrate skills in recognizing stereotypes, crafting postwar identities, and producing alternative representations of veteran identity which other veterans can then draw upon in their own homecomings. Presently, no unified theory of veteran identity exists. This dissertation begins that discussion, treating individual performances of veteran identity, existing historical, sociological, and psychological scholarship about veterans, and cultural representations of the wars they fight as equal parts of a single text. Further, it invites future considerations of veteran identity which build upon, challenge, or refute its claims. Conversations about veteran identity are the opposite of silence; they force awareness of war’s uncomfortable truths and homecoming’s eventual triumphs. Complicating veteran identity subverts conformity; it provides a steady stream of traits, qualities, and motivations that veterans use to craft postwar selves. The serious considerations of war and homecoming presented in this text will be useful for Iraq and Afghanistan War veterans attempting to piece together postwar identities; they will be useful to scholars hoping to facilitate homecoming for future generations of war veterans. Finally, the Afterword to the dissertation proposes a program for reassimilation capable of harnessing the veteran’s symbolic and moral authority in such a way that self-definition and homecoming might become two parts of a single act.

Through research, inquiry, and an evaluation of Recovery By Design, a ‘design therapy’ program that serves people with mental illness, substance use disorders, and developmental disabilities, it is my assertion that the practice of design has therapeutic potential and can aid in the process of recovery. To the novice, the practices of conception, shaping form, and praxis have empowering benefit especially when guided by Conditional and Transformation Design methods together with an emphasis on materiality and vernacular form.

Abstract Amidst the worst disaster to impact a major U.S. city in one hundred years, New Orleans’ main trauma and safety net medical center, the Reverend Avery C. Alexander Charity Hospital, was permanently closed. Charity’s administrative operator, Louisiana State University (LSU), ordered an end to its attempted reopening by its workers and U.S. military personnel in the weeks following the August 29, 2005 storm. Drawing upon rigorous review of literature and an exhaustive analysis of primary and secondary data, this case study found that Charity Hospital was closed as a result of disaster capitalism. LSU, backed by Louisiana state officials, took advantage of the mass internal displacement of New Orleans’ populace in the aftermath of Hurricane Katrina in an attempt to abandon Charity Hospital’s iconic but neglected facility and to supplant its original safety net mission serving the poor and uninsured for its neoliberal transformation to favor LSU’s academic medical enterprise.